tbuckley/cabot-search huggingface dataset:
Abstract 11654: Bundled Payments for Care Improvement Advanced and Cardiac Rehabilitation Participation After Acute Myocardial Infarction
Authors: Brittain Heindl, Vera A Bittner, Stephen Clarkson, Elizabeth A Jackson, Karen E Joynt Maddox, Todd Brown, Mei Li, Lei Huang, Emily B Levitan
Journal: Circulation (2022)

Introduction: Cardiac rehabilitation (CR) improves outcomes after acute myocardial infarction (AMI). The Bundled Payments for Care Improvement Advanced (BPCI-A) program holds participating hospitals accountable for all costs incurred within 90 days of discharge. There is concern that this financial incentive will lead participants to cut back on high-value care, including CR, in order to meet cost targets. We examined whether patients discharged from BPCI-A participating hospitals after an AMI had lower CR utilization compared to non-participating hospitals. Methods: We included patients from a 100% sample of fee-for-service Medicare beneficiaries discharged home after a hospitalization for AMI during a baseline period (January 1, 2016 to December 31, 2017) or an intervention period (October 1, 2018 to September 30, 2019). Our exposure was discharge from a hospital participating in BPCI-A. Our outcomes were the proportion attending ≥1 CR session and the mean number of CR sessions attended within 90 days of discharge. We adjusted for hospital, market, and patient level factors, including medical comorbidities. We performed difference-in-change analyses for both outcomes using linear mixed effects models, before and after adjustment for all confounders. Results: The baseline period included 50,274 discharges, with 33.7% from BPCI-A participating hospitals. The intervention period included 27,268 discharges, with 32.9% from participating hospitals. Overall, CR use was 11.3% in the baseline period and 11.7% in the intervention period. There were no differential changes between BPCI-participating and nonparticipating hospitals for either outcome over time ( Table ). Conclusions: Among Medicare patients discharged after an AMI, CR utilization was low, and we observed no difference in utilization associated with hospital participation in BPCI-A.
Abstract 11277: Impact of Sex-Specific Echocardiographic Evaluation on Outcome of Patients With Organic Mitral Regurgitation
Authors: Solenn Dal Soglio, Jeremy Bernard, Julien Pageau-Bleau, Erwan Salaun, Philippe Pibarot, Jonathan Beaudoin, Marie-Annick Clavel
Journal: Circulation (2022)

Background: In patients with organic mitral regurgitation (OMR), women are less often diagnosed with severe disease and less referred to intervention. One of the potential explanations is the use of non-indexed and non-sex-specific guideline’s-based triggers for surgery. Aims: To compare predictors of the composite of cardio-vascular hospitalization and mortality under medical management in men and women with OMR. Methods: Between January and December 2014, 295 women and 269 men were diagnosed with at least mild isolated OMR. Event-free survival was compared with the use of adjusted Cox regression and inverse probability treatment weighting. Best thresholds predicting the composite endpoint at 3 years were derives from the Youden index on ROC curves analyses in both sexes separately. Results: Mean age was 68.5 ±14.1 years and the majority of patients (46%) had moderate OMR. Severity of OMR was similar between groups and inverse propensity weighting was used to balance clinical characteristics between sexes. Despite unadjusted and adjusted similar even-free survival under medical management, left atrium (LA) and left ventricle (LV) cavities were larger in men than in women (all p&lt;0.001). Interestingly, even after indexation by BSA, thresholds associated with higher mortality were different between men and women (LV mass index: 118 g/m 2 in men, 88g/m 2 in women; LV ejection fraction: ≤ 55% in men, ≤ 65% in women; systolic pulmonary artery pressure: &gt;42mmHg in men, &gt;29mmHg in women), except for LA volume index (&gt;32ml/m 2 in both sexes) . The use of sex-specific thresholds improves the prediction of events (p=0.002). Conclusion: Management of OMR should integrate sex-specific cut-points to trigger intervention, even for echo parameters indexed to BSA in order to harmonize outcomes between men and women with OMR.
Abstract 11290: Sex Differences in the Progression and Long-Term Outcomes of Native Mild to Moderate Aortic Stenosis
Authors: Osamah Badwan, Essa Hariri, Nicholas Kassis, Habib Layoun, Serge C Harb, Samir R Kapadia
Journal: Circulation (2022)

Background: Despite evidence of sex-based divergences in the natural history of aortic stenosis (AS), there is limited data on the sex differences in the hemodynamic progression and long-term outcomes of early-stage AS. Methods: This is a retrospective longitudinal study of patients aged ≥ 60 years with mild to moderate native AS who were identified from a tertiary care referral center between 2008-2016 and followed until 2018. All patients had at minimum 2 echocardiograms. The primary outcomes of all-cause mortality and aortic valve replacement (AVR) were both assessed by time-to-event analyses with multivariable-adjusted Cox regression. The secondary outcome of AS progression was assessed by annualized changes in echocardiographic parameters in a 1:1 propensity-matched group of males and females. Results: Of 2,660 included patients followed over a median duration of 5.6 years, the mean age was 74 years and 1,128 (42%) were female. There was no difference in all-cause mortality between sexes, irrespective of age, baseline AS severity, and receipt of AVR. Relative to males, females had a lower risk of AVR (aHR=0.77, 95% CI [0.65-0.92]; p=0.004) irrespective of age, type of aortic valve and baseline severity of AS (Figure). This finding persisted on sensitivity analyses excluding patients with a history of coronary artery disease, prior coronary bypass surgery (CABG), and who underwent concomitant CABG and AVR. On 1:1 propensity-matched analysis, females had significantly slower annualized decrease in indexed aortic valve area (-0.039 vs. -0.021 cm 2 /m 2 /year, p=0.04) and slower increase in mean gradient (1.60 vs. 1.01 mmHg/year, p&lt;0.001),and maximum transvalvular velocity (0.08 vs. 0.11 m/s/year; p=0.04). Conclusion: In patients with mild to moderate AS, females had slower hemodynamic progression of AS and lower incidence of AVR despite similar mortality between sexes. Our findings suggest the need for sex-specific evaluation and management of native AS.
Abstract 11190: Subgroup Comparison of Electrocardiogram Deep-Learning Model Performance for Estimating Coronary Artery Calcium Score
Authors: Hakje Yoo, Sung Ho Hwang, Yunjin Yum, Jong-ho Kim, Hyung Joon J Joo
Journal: Circulation (2022)

Introduction: Despite the clinical usefulness of Coronary artery calcium score (CACS), it is difficult to use it as a routine practice due to its high cost and radiation hazard. Recently, several deep learning (DL) models to estimate CACS using 12-lead electrocardiography (ECG) have been introduced. However, their performance has not been compared among different patient groups. This study compared the performance of DL models to estimate CACS in different patient groups. Methods: The data of 5,427 patients who underwent both CT scan and 12-lead ECG at Korea University Anam Hospital from November 2012 to December 2021 was split into 80% training set and 20% test set. CNN-based DL model for predicting CACS ≥ 1 and CACS ≥ 100 using the raw ECG waveforms and several clinical factors as input was developed. Results: The DL model showed comparable performance for CACS estimation in the test dataset (area under the receiver operating characteristics curves [AUROCs] 0.77 for CACS ≥ 1 and 0.82 for CACS ≥ 100). The DL model showed better performance in patients with cardiovascular risks less than 3 compared to patients with cardiovascular risks more than 3 (AUROC 0.75 vs 0.71 for CACS ≥ 1, 0.77 vs 0.71 for CACS ≥ 100, Table 1). Among subgroups, the elderly (age &gt; 65 year-old) showed the lowest performance (AUROC 0.72 for both CACS ≥ 1 and ≥ 100). Interestingly, the model performance predicting CACS ≥ 1 is better in patients with normal sinus rhythm, whereas the model performance predicting CACS ≥ 100 is better in patients with non-normal sinus rhythm. This suggests that normal ECG can better predict healthy condition and abnormal ECG can better predict pathological condition. Conclusions: The performance of CACS estimation DL model could depend on the patient's cardiovascular risk factors. When applying the DL model to actual clinical practice, it is necessary to consider the performance of the DL model for the patient group to be applied and to selectively apply the appropriate DL model.
Abstract 11266: Trend, Predictors and Outcomes of Transcatheter Aortic Valve Implantation in Patients With End-Stage Renal Disease: Insights From the Nationwide Readmissions Database
Authors: Harigopal Sandhyavenu, Irisha Badu, Bhavin Patel, Aravind R Polam, Amro Taha, Waqas Ullah
Journal: Circulation (2022)

Background: Evidence on the safety of transcatheter aortic valve implantation (TAVI) in End-stage renal disease (ESRD) patients is limited. Methods: The Nationwide Readmissions Database (NRD) from 2015-2019 was queried to identify patients undergoing TAVI in ESRD versus patients with no ESRD. The in-hospital, 30-day, and 180-day outcomes were assessed using a propensity-score matched (PSM) analysis to calculate adjusted odds ratios (aOR). Results: A total of 198,816 underwent TAVI, of which 34,546 patients (TAVI-ESRD:16,986 vs non-ESRD:17,560) were selected on PSM analysis. The adjusted odds of net adverse cardiovascular events (NACE) (aOR 1.65, 95% CI 1.49-1.82), in-hospital mortality (aOR 2.99, 95% CI 2.52-3.55), major bleeding (aOR 1.21, 95% CI 1.05-1.40), postprocedural cardiogenic shock (aOR 1.54, 95% CI 1.11-2.13), permanent pacemaker implantation (PPM) (aOR 1.24, 95% CI 1.15-1.38) were significantly higher in TAVI-ESRD patients compared with non-ESRD patients at index admission. There was no significant difference in the odds of stroke (aOR 1.09, 95% CI 0.86-1.34) and cardiac tamponade (aOR 1.06, 95% CI 0.78-1.45) between two groups. Table 1. At 30-day follow-up, TAVI-ESRD patients had higher odds of major bleeding while there was no significant difference in outcomes of stroke, cardiac tamponade and PPM implantation between the two groups up to 180-day follow-up, Table 2. On trend analysis, the rate of utilization of TAVI in ESRD has significantly increased to 30% by 2019. Conclusion: The rate of utilization of TAVI in ESRD has significantly increased in recent years despite the higher risk of NACE, in-hospital mortality, major bleeding and PPM implantation.
Abstract 11101: Q Fever Endocarditis Combined With Thrombus and Antiphospholipid Syndrome
Authors: Jieun Lee, Hwan Seok Yong, Man-Jong Baek, Jin O Na, Jah Yeon Y Choi
Journal: Circulation (2022)

A 63-year-old-man presented to our institution with dyspnea. Transthoracic echocardiography (TTE) showed severe degenerative aortic stenosis with regurgitation and decreased left ventricular contractility. Subsequent transesophageal echocardiography (TEE) and cardiac computed tomography (CT) revealed an outpouching structure at aortomitral intervalvular fibrosa (AMIVF) (Fig A to D), which was compatible with pseudoaneurysm and suggested sequelae of previous infective endocarditis. On surgery, thickened AV leaflets were noted, especially on NCC and LCC (Fig E). When extracting the AV leaflets, subannular pouching was seen without evidence of active inflammation or infection (Fig F). AV replacement with 25-mm Sorin Mitroflow was performed.One-year TTE follow-up showed markedly increased transAV pressure gradient. TEE and cardiac CT revealed symmetric nodular thickening of bioprosthetic AV leaflets with opening limitation (Fig G to J). The patient was admitted on the diagnosis of subclinical bioprosthetic valve thrombosis, and anticoagulation with warfarin and aspirin was started. During the hospitalization, the patient had persistent fever with bicytopenia and hepatosplenomegaly, but repetitive blood cultures were negative. There was no definite fever focus even in 18F-FDG PET CT (Fig K). Since the patient worked on a farm in Dangjin, Chungcheongnam-Do, South Korea, where Q fever is prevalent, an indirect immunofluorescence assay for Coxiella burnetii was conducted and the result turned out to be positive. Additional coagulopathy laboratory findings showed positive for lupus anticoagulant, anti-cardiolipin IgM, and anti-beta2 GPI IgM. Finally, the patient was diagnosed with Q fever endocarditis combined with antiphospholipid syndrome and treated with doxycycline with hydroxychloroquine and maintained anticoagulation. Recent follow-up of TTE and cardiac CT showed complete resolution of prosthetic AV thrombus.
Abstract 11262: Effect of Active Cancer/Cachexia on the Development of Cardiac Dysfunction in Mice
Authors: Attila Kiss, Christopher Dostal, Luja Petra Szabo, Casian S Aioanei, Daniel Spona, Karin Zins, Dietmar Abraham, Latifa Bakiri, Erwin F Wagner, Bruno Podesser
Journal: Circulation (2022)

Introduction: Cancer is independently associated with the alteration of cardiac function prior to cardiotoxic chemotherapy (CCT) exposure. Similar to cancer associated cachexia (CAC), the elevation and the deleterious role of IL-6 in plasma was associated with a reduced cardiac function in heart failure (HF) patients subpopulation. Cancer cells manipulate BCL-2-associated athanogene 3 (BAG3)-HSP70-regulated pathways in tumor cells, which is a key regulator of protein turnover and contractility in cardiomyocyte. Hypothesis: Here, we aimed to characterize the progression of cardiac dysfunction and the expression of BAG3 and HSP70 in tumor-bearing mice. Methods: Colon-26 adenocarcinoma cells (C26; n=22) with/without shIL-6 (C26 shIL-6; n=22) were injected subcutaneously adult male BALB/c mice. Control mice were injected with PBS (n=13). Echocardiographic examinations and invasive hemodynamic measurements ( in vivo and ex vivo using isolated working hearts system) were performed at 10 (early) and 20 (late) days post injection, respectively. The expression of BAG3 and Hsp70 were determined by Western blot. Results: The tumor size was comparable between the cancer groups. However, only C26 group showed a significant loss of subcutaneous fat and skeletal muscle (p&lt;0.05, respectively), confirming cachectic condition. Echocardiography results show a tendency to decline of ejection fraction at the early phase (p~0.08 vs Control), and turned significance lower at late stage (p&lt;0.05 vs Control) in tumor-bearing mice. In line with that, invasive hemodynamic and isolated working heart measurements confirmed LV systolic and diastolic dysfunction (late stage, p&lt;0.05 vs Control, respectively). Interestingly, heart rate and aortic flow were predominantly declined in cachectic animals (p&lt;0.05 vs Control). Importantly, cardiac dysfunction was associated with a significant reduction in both BAG3 and Hsp70 in the myocardium independently of cachexia. Conclusions: Cancer rather than CAC is a main driver for the development of cardiac contractile dysfunction prior to CCT exposure. In addition, our data suggest that targeting BAG3-Hsp70 complex in the cardiomyocytes may provide a novel strategy to improve the cancer associated cardiac dysfunction.
Abstract 113: Protection Of Cardiomyocytes Against Hypoxia/reoxygenation Injury: Interaction Of Poloxamer 188 And Endothelial Cells
Authors: Zhu Li, Matthew B Barajas, Takuro Oyama, Miriam J Walter, Matthias L Riess
Journal: Circulation (2022)

Administration of Poloxamer (P) 188, a copolymer-based cell membrane stabilizer, significantly improves myocardial ischemia/reperfusion (IR) injury through its ability to protect cell membranes. Cell-to-cell interactions between endothelial cells (ECs) and cardiomyocytes (CMs) further protect CM from IR injury. Thus, we established a co-culture model of ECs and CMs and could previously demonstrate that the mere presence of ECs potentiates cardioprotection as evidenced by dose-dependent attenuation of LDH release from CMs caused by hypoxia/reoxygenation (HR). Here, we sought to determine if P188 can further potentiate the attenuation of LDH release in the presence of different ECs densities. Mouse CMs cultured in wells underwent 24 h hypoxia followed by 2 h reoxygenation. Mouse coronary artery ECs were plated in well-inserts at densities of 25,000, 50,000, or 100,000 per well which were placed into the CM wells. P188 at 0, 30, 100, 300, or 1,000 μM was administered upon reoxygenation. Statistics: ANOVA and SNK, alpha 0.05. ECs did not have a protective effect by themselves when a low number of ECs (25,000 per well) were present, but P188 could reduce LDH release in CMs after HR injury in a dose-dependent manner (lower panel). When a high number of ECs (100,000 per well) were co-cultured with CMs, ECs themselves exerted a protective effect while P188 did not further decrease LDH release significantly (upper panel). An intermediate number of ECs (50,000 per well) did not produce significant results in either direction (center panel). Our data suggests that the EC-mediated protection of CMs depends on EC density; furthermore, while at low density the role of ECs was limited and allowed P188 to promote additional protection against HR injury, at high density ECs appeared to saturate cardioprotection and blunt additional P188’s CM protection. These findings suggest an important, yet not additive interaction between the protection conferred by ECs and that by P188.
Abstract 11582: Implications of Glycoprotein 2b/3a Receptor Antagonist Use During Percutaneous Coronary Intervention
Authors: Michael E Sternberg, ERIC WILLIAMS, Clifford E Fonner, Gregory Dehmer, DAVID C Sane
Journal: Circulation (2022)

Introduction: Glycoprotein 2b/3a receptor antagonists (Gp 2b/3a) were once widely used during PCI. However, due to concerns for excess bleeding, the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization downgraded their use during PCI to Class IIa. Hypothesis Higher rates of Gp 2b/3a use will be associated with higher bleeding rates, particularly in hospitals that use more femoral arterial access. Methods: We investigated the prevalence of Gp 2b/3a use during PCI among 18 PCI centers in a regional cardiac quality collaborative, between January 2017 and June 2021. Since radial access has lower bleeding rates than femoral access, we determined the impact of Gp 2b/3a use on total bleeding as defined by NCDR, stratified by access site. Results: During the study period 36,975 PCI were performed. The rate of Gp 2b/3a use among PCI centers ranged from 2.6% to 59.3% (mean ± SD 20.5% ± 18.5%). PCI centers were analyzed according to whether Gp 2b/3a use was above or below the mean frequency, and according to arterial access site preference (femoral &gt; 45% or radial &gt; 55%). Among low Gp 2b/3a use centers, centers that also favored radial access had lower bleeding rates than high femoral access centers (1.84% vs 2.43%, p=0.009). However, the bleeding risk benefit of radial access was lost in the high Gp 2b/3a usage hospitals, with bleeding rates of 4.54% in the high radial centers versus 3.41% in the high femoral centers (p&lt;0.001) (Table). Among high radial access site centers, the rate of bleeding was 2.5-fold greater in high versus low Gp 2b/3a use centers (p&lt;0.001). Conclusions: There is a wide range of Gp 2b/3a use during PCI. Above average Gp 2b/3a use increased total bleeding and neutralized the bleeding risk benefit of radial access. Further study is required to determine why bleeding rates in high radial centers were greater than high femoral centers, when Gp 2b/3a use was above average. Adherence to current guidelines for Gp 2b/3a use may reduce bleeding risk during PCI.
Abstract 11308: Genome-Wide Polygenic Risk Scores Incoronary Artery Disease Risk Prediction: Results From the Asian Indian Diabetic Heart Study/Sikh Diabetes Study
Authors: Madhusmita Rout
Journal: Circulation (2022)

Introduction: Polygenic risk score (PRS) has been shown to be highly effective in predicting coronary artery disease (CAD) risk in Western European populations. However, such studies on South Asians are scarce despite the fact that they account for 50% of the global burden of CAD. Hypothesis: In this study, we evaluated the predictive efficacy of PRS derived from the Asian Indian (AI) ancestry-specific score (PRS AI ) and European-derived PRS (PRS EU ). Also, we compared these with the clinical risk score (CRS). Methods: The study used 4602 participants (791 CAD cases and 3790 controls) from the Asian Indian Diabetic Heart Study/Sikh Diabetes Study. Weighted PRS was constructed using 100 significant SNPs from our Punjabi/Sikh CAD GWAS and 75 SNPs identified from the European GWAS catalog. The CRS was derived using the clinical risk factors described for the Framingham risk score. Results: Ancestry-specific PRS AI showed an enhanced efficacy of over 30% in estimating the relative risk for CAD over PRS EU . In sensitivity analysis, the area under the curve (AUC) for PRS AI and PRS EU were 0.84 and 0.72, respectively, while the AUC remained unchanged on combining the PRS (AI+EU) , i.e., 0.84. PRS AI also predicted the risk for increased waist to hip ratio (β=0.11, p=4.1x10 -13 ) in both gender, while fasting glucose levels (β=0.08, 3.0x10 -3 ) were confined to females. Conclusions: The results highlight evidence for the utility of PRS for identifying genetically predisposed high-risk individuals and attest to its broader clinical value. Also, sex differences may play a role in determining the risk for CAD, and increased fasting glucose and type 2 diabetes (T2D) are known to increase the risk of heart disease in women more than men, especially after menopause.